“Evidence-based medicine” refers to a set of principles and methods to ensure that, to the greatest extent possible, individual decisions and population-based policies are consistent with the evidence of their effectiveness and benefit [1]. The term that was coined less than 20 years ago by Gordon Guyatt at McMaster University has grown from a fledging concept to the fundamental basis of clinical practice that reaches into all aspects of medical practice [2].

The importance of evidence-based medicine and evidence-based clinical practice is highlighted by the fact that statements encouraging adherence to these principles are included in the landmark health care reform legislation enacted in the United States in 2010 and is guiding health care policy in countries such as the United Kingdom. With increasing recognition that greater adherence to evidence-based practice can improve quality of care and reduce costs, it is critically important that all practitioners in urology understand the underpinnings of the concepts of evidence-based medicine as well as its applicability and limitations.

This issue of the World Journal of Urology pays tribute to the remarkable and growing impact that evidence-based medicine has had on the practice of urology. It includes eleven articles written by recognized experts in the field that provide in-depth analyses of the influence of evidence-based medicine on key areas of clinical practice, education, publishing, health policy, and clinical research.

Lavallée et al. explore the current and future role of randomized controlled trials—recognized as leading the “hierarchy of evidence” as the best original study design to provide high quality evidence for questions of therapeutic effectiveness—in guiding the clinical practice of urology. It is followed by studies by Porten et al. and Yu et al. that provide similar analyses of the roles of observational study designs/registries and health services research, respectively, in addressing the most important evidence gaps in urology. The following two articles by Wang et al. and Shelton et al. put these findings into perspective by discussing the growing importance of comparative effectiveness research as well as their implications for health policy decision-making.

Recognizing the critical role of clinical practice guidelines to guide evidence-based clinical practice, MacLennan et al. discuss the value of clinical pathways as a guide to their development; an approach that is being promoted by the European Association of Urology and The British Association of Urological Surgeons guideline developer groups. Wolf et al. analyze the considerable efforts of the American Urological Association (AUA) as an example of how rigorous methodology can feasibly be applied to the development of evidence-based recommendations. A review by Canfield et al. then discusses the GRADE approach for rating the quality of evidence and strengths of recommendations. It provides a transparent and methodologically rigorous framework for developing clinical practice guidelines that has been adopted by over fifty professional organizations all over the globe (http://www.gradeworkinggroup.org). GRADE holds the promise of becoming the unifying methodological framework for guideline developers, which would allow enhanced collaboration and improved resource utilization for professional urological organizations.

Sharrock et al. provide a critical analysis of the important role that editors and publishers play in promoting the principles of evidence-based medicine. An article by Charles Scales, Jr. provides an overview of the increasing number of urology-specific resources that have become available for Urologists to learn more about evidence-based medicine and enable them to apply its principles to their clinical practice. These include the AUA Core Curriculum on evidence-based medicine, the Users’ Guide to the Urological Literature series [3], the Evidence Based Urology in Practice series [4] as well as the AUA’s Evidence Based Reviews in Urology online journal club (http://www.auanet.org/eforms/ebru). This issue concludes with a thought-provoking article by Peter McCulloch, one of the leaders of the IDEAL Working Group [5]. IDEAL stands for Idea, Development, Evaluation, Assessment, and Long-term study, which describe the proposed phases of surgical innovation. The article challenges Urologists to rethink the paradigms of surgical research by shifting from being retrospective “hunter-gatherers” to hypothesis-driven prospective investigators.

We appreciate the tremendous opportunity provided by the World Journal of Urology to assemble the contributions of so many recognized leaders in the field on the very timely topic of evidence-based medicine. It is our hope that the articles of this special issue will inspire generations of future researchers, clinicians, educators, and policy-makers in urology to promote the principles of evidence-based medicine with the ultimate goal of improving the quality of care of the patients we serve.